Provider Demographics
NPI:1245354562
Name:MITCHELL, PAMALA A (DC)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9179 GRISSOM RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2809
Mailing Address - Country:US
Mailing Address - Phone:210-680-5133
Mailing Address - Fax:210-680-4772
Practice Address - Street 1:9179 GRISSOM RD
Practice Address - Street 2:SUITE 131
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2809
Practice Address - Country:US
Practice Address - Phone:210-680-5133
Practice Address - Fax:210-680-4772
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U7420OtherBC/BS
TXTXB104726Medicare PIN